Final Bill Includes First Federal Provider Non-Discrimination Standard to Target Exclusionary ERISA Plans, Designates Children's Vision as an Essential Benefit, and Preserves State Patient Access to Care Laws
WASHINGTON, D.C. (March 21, 2010) - The U.S. House of Representatives today gave final approval to a far-reaching $940 billion health care overhaul bill pushed by President Obama and his allies in Congress, which seeks to extend health insurance coverage to 32 million Americans through a system of 50 state-based health insurance exchanges to be administered by the states and subject to state laws, re-shape Medicare and other Federal health programs and impose new requirements on health insurers. Included in the more than 2000-page measure is a landmark provision sponsored by Sen. Tom Harkin (D-Iowa), and backed by the 36,000-member American Optometric Association (AOA) during a year-long grassroots campaign, that is designed to outlaw discrimination against optometrists and other providers by health plans, including self-insured ERISA plans. The legislation passed the U.S. Senate late last year, and with House passage today, is expected to be signed into law by President Obama.
"The approval of the Harkin Amendment is a tremendous victory for optometry and will likely prove to be one of the most historic advances in patient access to optometric care since the 1986 recognition of optometrists as physicians under Medicare," said AOA President Randolph Brooks, O.D. "AOA's top priority in Washington, D.C. throughout this process has been to expand patient access and put a stop to the health plan discrimination we have faced for too long. Today, thanks to Senator Harkin and other "access-to-care" leaders in Congress, organized medicine and every health plan in America, including ERISA plans, are on notice that their unfair restrictions to the full scope of eye health care we provide are ending."
The final version of the overhaul bill includes a number of other important AOA-backed provisions aimed expanding access to optometric care, including the specific designation of vision care for children as an essential health benefit - where current vision care plans may partner with major health plans to satisfy children's essential benefit requirements; full application of state insurance laws to each of the 50 state health insurance exchanges through which tens of millions of uninsured Americans will purchase coverage; new emphasis on the pro-access "health care home" model of patient-centered care coupled with a key rejection of the exclusionary "medical home" scheme; and safeguards for existing vision coverage provided through stand-alone vision care plans.
"Our organization mobilized as never before to become a force in the Washington, D.C. battle over national health care reform, and the AOA-backed patient access provisions included in the final bill show it," said AOA President-Elect Joe Ellis, O.D. "I'm proud of the role optometry has played in making vision care for kids an essential health care benefit. I'm proud, too, that millions more Americans will gain access to their local doctor of optometry because Federal law will now target the discriminatory practices of health plans. And I'm especially proud of the work we have done - with Rep. Mike Ross (D-Ark.) and other pro-optometry leaders in the House - to preserve existing state-based provider non-discrimination and patient access to care laws."
A separate technical bill related to the health care overhaul, know by many as the "reconciliation package", was also approved by the House today and forwarded to the Senate for final consideration, possibly this coming week. This separate technical bill would also provide an exemption for eyeglasses and contact lenses from a new 2.9% medical device excise tax and an exemption for the cost of vision coverage from the calculation of a new tax on high-cost health plans. Both provisions were supported by the AOA.
There are provisions AOA supported over the last year that were considered by Congress but not included in the final version of the bill, including full recognition of optometrists in Medicaid (House-passed Schakowsky Amendment based on HR 2697); statutory inclusion of optometrists in Federal health programs, including the National Health Service Corps (committee-passed Gordon Amendment based on HR 1884); and expansion of Federal eye health efforts targeting infants (Byrd Amendment). Also left out was a statutory requirement concerning non-pre-emption of state patient choice laws authored by Rep. Mike Ross (D-Ark.), which would have been an essential safeguard had a plan to establish a centrally-controlled interstate health insurance exchange advanced into the final bill. However, as the final bill seeks to establish 50 state insurance exchanges to be administered by individual states, the Ross Amendment was no longer required to protect existing state-based provider non-discrimination laws.
"The AOA - through the tireless efforts of national and affiliate leadership, Advocacy Group volunteers, Federal Keypersons, AOA-PAC investors and concerned doctors and students from across the country - has stood for patient access in the national health care battle of our time and prevailed," said AOA Washington Office Director Jon Hymes. "Although this victory affords an opportunity to appreciate how optometry's advocacy efforts have progressed, it doesn't mark the end of the profession's fight for its patients or to pro-actively define its own future."
The giant health insurance lobby and organized medicine opposed the Harkin Amendment at each step of the legislative process. In a final, failed plea to Capitol Hill this week, one medical specialty group called on Congress to reject "the so-called "non-discrimination" provisions seek[ing] to elevate paraprofessionals in the health care marketplace by prohibiting health plans from appropriately differentiating between physicians and those paraprofessionals."
"As the health care legislation is implemented, the AOA and its members must be prepared to provide even more determined advocacy for optometry in Washington, D.C. and state capitals, in the media, in the ophthalmic community and among employers and payers," Hymes added.
About the American Optometric Association
American Optometric Association (AOA) doctors of optometry are highly qualified, trained doctors, on the frontline of eye health and vision care, who examine, diagnose, treat, and manage diseases and disorders of the eye. In addition to providing eye and vision care, optometrists play a major role in an individual's overall health and well-being by detecting systemic diseases. Doctors of optometry have the skills and training to provide more than two-thirds of all primary eye care in the United States. The AOA represents more than 36,000 doctors of optometry, optometry students and paraoptometric assistants and technicians in nearly 6,500 communities across the country. For more information, visit www.aoa.org.